The revision to the parent grant, 5 R01 DK081371-02: "Identifying Disparities in Type 2 Diabetes Among Asian Americans: The Pan Asian Cohort Study," is in response to NOT-OD-09-058: "NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications." The parent grant is funded from January 15, 2009 - December 31, 2013 in response to Program Announcement PA-07-388: "Identifying and Reducing Diabetes and Obesity Related Health Disparities within Healthcare Systems (R01)." This five-year study addresses the lack of knowledge regarding type 2 diabetes and obesity in Asian Americans, both as an aggregate group and as distinct subgroups. Relatively little is known about how Asian subgroups differ in type 2 diabetes riskfactors and complications when compared to the Non-Hispanic White population, for which numerous study findings have informed both practice of care and public health efforts in the United States. The parent grant utilizes a mixed historical and prospective longitudinal cohort to address these research questions of significant public health import, linking existing clinical databases to construct a large (140,000 Asian adults) cohort of a multiethnic sample of contemporary Asians in California. The revision, a two-year study, aims to additionally compare the effectiveness of oral drugs for treatment of type 2 diabetes among Asian subgroups in the same electronically linked cohort. It is well-known that type 2 diabetes manifests differently in race/ethnic groups, and that race/ethnic groups respond differently to the same pharmacotherapy. Treatment options for type 2 diabetes are numerous, and previous studies have demonstrated differences in metabolic responses to certain oral drugs according to race/ethnicity. This creates a need for more race/ethnic specific data comparing the effects of medication use to be able to improve diabetes care in Asian Americans in the United States. The wealth of real-life data captured within the clinical cohort will be utilized to compare the effectiveness of oral drugs to treat type 2 diabetes among Asian subgroups and to study existing preferences for certain drugs among patients and physicians. Predictors of initial choice of oral drug (in physicians and patients), intermediate and long-term effectiveness of existing oral drugs on type 2 diabetes and its complications, and the cost-effectiveness of these therapies will be investigated under this competitive revision. This revision will contribute valuable knowledge for physicians, patients, and public health advocates on the clinical and cost effectiveness of various oral type 2diabetes therapies in Asian Americans. PUBLIC HEALTH RELEVANCE: Asian Americans (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) are disproportionately affected by type 2 diabetes. There is no data on comparative effectiveness of oral drugs to treat type 2 diabetes in Asian American subgroups. Our study will address this gap in knowledge.